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Vacant Lot or Unoccupied Business FOG Application Notification

This property is:*
1. Vacant unimproved lot
2. Unoccupied commercial business
Business Name
Property Owner Information:
First Name
Last Name
Email*
Phone Number*
Property Address:
Street Number*
Unit #
Street Name*
Mailing Address Street #/POB (If different from property address)
City
State
Zip Code
HDWD Account Number:
By Checking this box I solemnly affirm under the penalties of perjury, and to the best of my knowledge, information and belief, that the contents of this application are true and complete.*
1. Yes
Owner/Authorized Representative*
Title*
Date*
Date

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